The Impact of the COVID-19 Pandemic and Lockdowns on Sex Workers in West Bengal, India.

India's COVID-19 lockdowns were among the strictest globally, and sex workers were uniquely impacted. Extremely limited literature has examined pandemic consequences on sex workers. We use a qualitative approach to examine the impact of the COVID-19 pandemic and lockdowns on the lives and livelihoods of sex workers in urban West Bengal, India. Cisgender female and male, and transgender female sex workers (N = 40) participated in individual in-depth interviews. Interviews were coded using inductive thematic coding. Nine themes arose from the data: (1) COVID-19 pandemic and lockdowns, (2) Social isolation, (3) Lack of customers, (4) Financial stress, (5) Decreased negotiating power, (6) Food insecurity, (7) Receiving support, (8) Providing support, and (9) Mental health. We propose a Gendered Stress Proliferation Model incorporating Pearlin et al.'s 1997 conceptualization of stress proliferation and Swendeman, Fehrenbacher et al.'s 2018 gendered stress process model. In this model, primary stressors of COVID-19 pandemic and lockdowns proliferated into secondary stressors across multiple domains (social isolation, lack of customers, financial stress, food insecurity, reliance on support, decreased negotiating power). All of these pathways were shaped by pre-existing vulnerabilities and systems of intersectional marginalization. These stressors had significant mental health impacts including feelings of depression and anxiety. Food insecurity has implications for physical health outcomes, and financial stress coupled with decreased negotiating power has implications for sexual health, potentially placing sex workers at increased risk of sexually transmitted infections and HIV. Gendered Stress Proliferation may be a useful framework to examine how marginalized populations uniquely experience population-level crises.